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Elisabeth Rosenthal’s “Insured, but Not Covered”

Elisabeth Rosenthal’s “Insured, but Not Covered”

Insured, but Not Covered

By Elisabeth Rosenthal
The New York Times, February 7, 2015

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

The theory behind the policies is that patients should bear more financial risk so they will be more conscious and cautious about health care spending. But some experts say the new policies have also left many Americans scrambling to track expenses from a multitude of sources — such as separate deductibles for network and non-network care, or payments for drugs on an insurer’s ever-changing list of drugs that require high co-pays or are not covered at all.

For some… narrow networks can necessitate footing bills privately. For others, the constant changes in policy guidelines — annual shifts in what’s covered and what’s not, monthly shifts in which doctors are in and out of network — can produce surprise bills for services they assumed would be covered. For still others, the new fees are so confusing and unsupportable that they just avoid seeing doctors.

(B)y endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.

Readers Comments:

Don McCanne
San Juan Capistrano, CA

The private insurance industry will always place a priority on optimizing its business model, which means maximizing revenues (premiums) and minimizing expenses (payments for patient care). Earlier managed care models proved unpopular because of denial of care, but now they have devised innumerable methods of denying payment instead, in full or in part. Many examples are found in this article.

In sharp contrast, an insurer owned by the public, such as Medicare, has a mission of serving patients. That is, our own public stewards are there to help us get the care we need. They are not there to try to produce a profit for the government; after all, its our own tax dollars.

We are close to the threshold wherein the public will no longer tolerate private insurers shifting ever more costs onto patients with health care needs, while taking away our choice of our health care professionals.

What is our way out? Improve Medicare and expand it to include everyone.

Len Charlap
Princeton, NJ

Some conservative commenters have pointed to Switzerland as a country which only uses private insurance companies and appears to have a system that works.

  1. The Swiss government writes a basic policy that all companies are required to offer with no change. Thus all the chicanery reported in the article is avoided. The policy is accepted by all doctors. People know exactly what they are getting. Everyone must have the basic policy.
  2. The private insurance companies may make no profit on the basic policy.
  3. The health care results of Switzerland are about average among the 10 or 12 wealthiest countries which is to say they are considerable better than we get.
  4. If the cost of insurance is more than 8% of a family’s income. they receive a subsidy from the government. About 40% receive such subsidies.
  5. We pay about 50% more for health care than the Swiss, but the Swiss pay almost 50% more than the other wealthy countries most of which use a variation of single payer.
  6. The Swiss government and insurance companies pay careful attention to the practices of its physicians wrt to poor practice, unnecessary tests, and overcharges. A suspected doctor will receive a dreaded “blue letter” from the insurance company requiring him to justify his practice.

If we can’t have an efficient single payer system like the UK or Canada, for example, I would settle for something like the Swiss system. It would do away with most of the scams illustrated in Rosenthal’s great series.

Don McCanne
San Juan Capistrano, CA

In Reply to Len Charlap

The Swiss health care system is certainly superior to what we have in the United States, precisely because of the reasons cited by Dr. Charlap. However, a comprehensive report by OECD and WHO of the Swiss system was released in 2011, and, if you read it carefully, you will also find these features of the Swiss system – features they share with us:

  • Highly inefficient and fragmented
  • Profound administrative waste
  • Inequitably funded
  • Regressive financing
  • Wide variations in premiums
  • Highest out-of-pocket costs
  • Increasing managed care intrusions
  • Insurers game the system

Because of the inadequacies of the Affordable Care Act we need to return to the negotiating table to fix our health care system. But when we do, let’s not start from a position of compromise, thereby allowing private insurers to continue to inflict these abuses on us. Let’s begin with a bona fide single payer system – an improved version of Medicare that covers everyone.

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Comment:

By Don McCanne, MD

This may be the most important article in Elisabeth Rosenthal’s outstanding series on health care costs and pricing in the United States. She shows that the Affordable Care Act failed to prevent private insurers from reducing their own risks by shifting much more of the costs onto patients, while reducing patient choice by further limiting their networks of approved providers.

Both access and affordability are worse now than they were with typical plans available a generation ago. The nation expanded the numbers covered by insurance, but at a cost of of leaving too many patients broke and without adequate access to care.

In my first posted response to her article, I repeated our oft-expressed view that it makes a difference on whether we finance health care through private insurers structured to optimize their business success or though public insurance designed specifically to serve patients. Elisabeth Rosenthal shows that what is good for insurers is bad for patients.

Some may wonder why I included two responses on the Swiss health care system when this article is on the poor quality of private health plans in America.

First I want to say that Len Charlap is one of the more astute and ethically-driven commentators in the readers’ response sections of The New York Times. His highly appropriate response to this article explains that our private insurance products could be greatly improved if we adopted the policies that the Swiss have in their country to regulate and control the excesses of the private insurance industry. Such a system theoretically would be more politically feasible in the United States since it is supported by a few prominent conservatives such as Harvard Professor Regina Herzlinger. 

We definitely do need to return to the negotiating tables since the ACA reforms are intolerably flawed. Although I certainly agree with Len Charlap that the Swiss system definitely would be superior to what we have, I do have a problem supporting a Swiss-style private insurance model as our opening position on renegotiating reform. Imagine having to compromise with those on the far right who would insist that patients have greater financial exposure to the health care that they receive. They would perpetuate and make even worse the very problems that Elisabeth Rosenthal discusses in her article.

The reason that I am reposting our responses here is that Len Charlap’s comment received very high exposure since it was selected and displayed as a “NYT Picks” and at the top of the list of “Readers’ Picks.” On the other hand, my response to him was held until some time after the comments section was closed, and then, when it was posted, it was buried under 300 plus responses, and thus had virtually no visibility.

My response to him listed findings from a OECD/WHO report that revealed that the Swiss private insurance plans, though certainly better than ours, still had many serious deficiencies that we should reject as we go back to the tables to fix our sick system. Many NYT readers may assume from Len Charlap’s comment that the Swiss system is the answer, or at least a reasonable compromise with broad political support (except that the current Republican proposals move even further away from the highly regulated Swiss system).

So the point of discussing these comments on the Swiss system is found in my concluding remark in my second post above:

“Because of the inadequacies of the Affordable Care Act we need to return to the negotiating table to fix our health care system. But when we do, let’s not start from a position of compromise, thereby allowing private insurers to continue to inflict these abuses on us. Let’s begin with a bona fide single payer system – an improved version of Medicare that covers everyone.”

Insured, but Not Covered

By Elisabeth Rosenthal
The New York Times, Feb. 7, 2015

When Karen Pineman of Manhattan received notice that her longtime health insurance policy didn’t comply with the Affordable Care Act’s requirements, she gamely set about shopping for a new policy through the public marketplace. After all, she’d supported President Obama and the act as a matter of principle.

Ms. Pineman, who is self-employed, accepted that she’d have to pay higher premiums for a plan with a narrower provider network and no out-of-network coverage. She accepted that she’d have to pay out of pocket to see her primary care physician, who didn’t participate. She even accepted having co-pays of nearly $1,800 to have a cast put on her ankle in an emergency room after she broke it while playing tennis.

But her frustration bubbled over when she tried to arrange a follow-up visit with an orthopedist in her Empire Blue Cross/Blue Shield network: The nearest doctor available who treated ankle problems was in Stamford, Conn. When she called to protest, her insurer said that Stamford was 14 miles from her home and 15 was considered a reasonable travel distance. “It was ridiculous — didn’t they notice it was in another state?” said Ms. Pineman, 46, who was on crutches.

She instead paid $350 to see a nearby orthopedist and bought a boot on Amazon as he suggested. She has since forked over hundreds of dollars more for a physical therapist that insurance didn’t cover, even though that provider was in-network.

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

Full article: http://www.nytimes.com/2015/02/08/sunday-review/insured-but-not-covered.html

Pharmaceutical manufacturers create distrust of vaccinations

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, Letters, Feb. 7, 2015

Children should get vaccinated. The evidence is overwhelming that this is a safe and effective vital strategy for our nation’s health.

Why is there such distrust of vaccinations today?

The answer is simple: Pharmaceutical manufacturers have repeatedly proven themselves as undeserving of our trust.

In 2010, AstraZeneca was fined $520 million for an array of illegal promotions of antipsychotics for children, elderly, veterans and prisoners. That fine sounds large, but it amounted to only 2.4 percent of the $21.6 billion that they made on Seroquel sales the preceding 12 years.

They’re not alone. Glaxo was fined $3 billion for the illegal promotion of two antidepressants and for hiding safety problems with a diabetes drug. Johnson and Johnson was fined $2.2 billion for the illegal marketing of Risperdal. Again: just tiny fractions of their total sales.

Their strategy seems to be “pay the ticket, but keep on speeding.”

We should be able to rely on the Food and Drug Administration to protect us, but the FDA’s advisory boards are now stacked with people who have a financial interest in the very drugs being regulated. Moreover, the FDA’s funding is dependent on the pharmaceutical companies.

Until we achieve a nonprofit national health program where medications are provided as a public good and not sold as commodities for the highest profit, trust in medicine will continue to erode.

Vaccinate your children. Urge financial and clinical independence for the FDA. And tell your lawmakers you want patient-oriented, not profit-oriented, health care. That will help bring trust back.

Dr. Ed Weisbart is chairman, Missouri chapter of Physicians for a National Health Program. He resides in Olivette.

http://www.stltoday.com/news/opinion/mailbag/pharmaceutical-manufacturers-create-distrust-of-vaccinations/article_f799633c-a861-5cbf-b072-462eca90afda.html

Congress shares the blame for high drug prices

By Suzanne Hagan
St. Louis Post-Dispatch, Letters, Feb. 11, 2015

Dr. Ed Weisbart is correct with the letter “Pharmaceutical manufacturers create distrust of vaccinations” (Feb. 7). Pharmaceutical manufacturers have many sins for which they must atone when it comes to the fleecing of American consumers.

But our spineless Congress has to shoulder a share of the blame. Sen. John McCain is the co-sponsor of a bill that enables a few Americans who live in a state bordering Canada to go to our northern neighbor to legally purchase their American-made drugs at a big discount. But Americans as a whole do not share in this benefit. That’s because the powerful lobbyists for Big Pharma made sure that Congress legislated that Americans pay full retail price for drugs we purchase.

Big Pharma tries to justify this position by citing the high cost of research and development for new drugs. But these companies receive tax breaks and other inducements that help defray costs, all subsidized by the American taxpayer. And why should we Americans subsidize the rest of the world’s drug costs? There should be global support of pharmaceutical R&D. Let’s face it: If these companies weren’t making huge profits, they couldn’t afford their army of well-funded lobbyists.

We need journalists to expose these outrages before we have any hope of correcting them. And as Dr. Weisbart pointed out, if we had a national single-payer health plan like Canada’s, we wouldn’t be in this position.

Suzanne Hagan resides in Ballwin, Mo.

http://www.stltoday.com/news/opinion/mailbag/congress-shares-the-blame-for-high-drug-prices/article_5b8dd359-d19b-5ee2-aeed-363b1b356a58.html

Burr, Hatch, and Upton’s Obamacare Replacement Plan

Burr, Hatch, Upton Unveil Obamacare Replacement Plan

Press Release from Senator Richard Burr (R-N.C.), February 5, 2015

Today, U.S. Senator Richard Burr (R-N.C.), Senate Finance Chairman Orrin Hatch (R-Utah), and House Energy and Commerce Chairman Fred Upton (R-Mich.) unveiled the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act — a legislative plan that repeals Obamacare and replaces it with common-sense, patient-focused reforms that reduce health care costs and increase access to affordable, high-quality care. In contrast with Obamacare and its government-centered mandates and regulations, this bicameral proposal empowers the American people to make the best health care choices for themselves and their families. 

The Patient CARE Act provides a legislative roadmap to repeal the President’s health care law known as Obamacare and replace the law with common-sense measures that would:

Establish sustainable, patient-focused reforms:

  • Adopt common-sense consumer protections;
  • Create a new protection to help Americans with pre-existing conditions;
  • Empower small businesses and individuals with purchasing power;
  • Empower states with more tools to help provide coverage while reducing costs; and
  • Strengthen consumer directed health care and allow Americans to buy coverage across state lines.

Modernize Medicaid to provide better coverage and care to patients:

  • Transition to capped allotment to provide states with predictable funding and flexibility.

Reduce defensive medicine and rein in frivolous lawsuits:

  • Medical Malpractice reforms.

Increase health care price transparency to empower consumers and patients:

  • Require basic health care transparency to inform and empower patients.

Reduce distortions in the tax code that drive up health care costs: 

  • Cap the exclusion of an employee’s employer-provided health coverage.

Empower Small Businesses and Individuals with Purchasing Power:

  • Targeted tax credit to help buy health care.

http://www.burr.senate.gov/public/index.cfm?FuseAction=PressOffice.PressReleases&ContentRecord_id=854e8329-e090-eb62-8d79-0c35859541ae

The Patient Choice, Affordability, Responsibility, and Empowerment (Patient CARE) Act: http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/114/20150205-PCARE-Act-Plan.pdf

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Comment:

By Don McCanne, MD

The Affordable Care Act has fallen far short of the health care reform that America desperately needs, and the Republicans have repeatedly voted for its repeal. To supposedly show that they are sincere about wanting to fix our health care system, they have introduced The Patient Choice, Affordability, Responsibility, and Empowerment (Patient CARE) Act – not formal legislation but rather a nine page white paper (accessible at the link above).

Although some have labeled this the Republican response to the Affordable Care Act, House speaker John Boehner has assembled another task force to prepare what presumably will be a more formal response, though likely only a more detailed version of this proposal.

When you read past the glowing rhetoric of this white paper, it becomes obvious that this is merely a rehash of several of the policies that Republicans have supported for the past few decades. They would remove mandates for insurance coverage, open the markets to plans with grossly inadequate, stripped-down benefits, sell insurance plans across state borders in a race to the bottom, shift more of the responsibility of paying for care to patients in need, expand the use of high deductible health plans, expand the use of health savings accounts (which do not work when they are empty), shift more of the responsibility of funding care for the poor to the cash-strapped states through Medicaid block grants, make comprehensive plans even less affordable by taxing them, establish under-funded high-risk insurance pools that are too small to meet the need, etc., etc.

These policies will leave more people uninsured, and the majority of those with insurance will end up with lousy plans because they will not be able to afford more comprehensive benefits. These plans will impair access and expose patients to financial hardship and even personal bankruptcy. With fewer funds directed to health care, our health delivery infrastructure could deteriorate, negatively impacting care for even the affluent.

However, the Republicans are doing us a favor. They are publicizing the deficiencies of the flawed reform program brought to us by the Democrats, and they are exposing their own flawed concepts of reform. That provides us with an opportunity to reenter the national dialogue on health care reform. Instead of continuing to rummage through bad policies, we can inject into the debate single payer policies that are truly effective. With the 2016 presidential political season already underway, we need to be sure that voters understand that their health care depends on the policies supported by the politicians they elect.

Yesterday’s message was about John Geyman’s book, “How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans” – a book written specifically for the purpose of ensuring that single payer occupies a prominent position in today’s political arena. For those who missed it yesterday, the message can be accessed here.

America’s New Single-Payer Majority

By Rep. John Conyers
The Huffington Post, Feb. 5, 2015

The Republican-led House of Representatives just unsuccessfully attempted to undo the Affordable Care Act for the 56th time.

While it’s been well established that repealing Obamacare without a plausible replacement would leave tens of millions of people uninsured and worsen our deficits by accelerating the growth in healthcare costs, it’s also important to note that this continued GOP crusade to get government out of health care runs directly counter to the stated will of the majority of Americans.

A new poll shows that more than half of Americans — including 80 percent of Democrats and a quarter of Republicans — support expanding health reform to “Medicare for All.” While Obamacare has been a step in the right direction, more and more people across the country understand that a single-payer healthcare system is the only way to guarantee quality care and at the same time reduce medical costs.

The United States spends almost twice as much per person on health care as any other country, yet our key outcomes — life expectancy, infant mortality and preventable deaths — too often lag behind our peers. A recent Commonwealth Fund study ranked the U.S. healthcare system dead last among 11 highly developed countries in terms of quality, efficiency and access to health care.

What are we doing wrong?

One major problem is that billing and insurance-related administrative costs — in other words, bureaucratic red tape — cost the American people $471 billion in 2012. That’s enough money to pay for our country’s whole interstate highway system. At least 80 percent of that extraordinary cost was, according to a respected study, due to inefficiencies in our for-profit, multipayer healthcare system.

By adopting a “Medicare for All” model — which, by the way, is the standard for health care throughout the industrialized world — we can achieve hundreds of billions of dollars in cost savings that can be used to cover the nation’s remaining uninsured and upgrade coverage for millions of underinsured citizens. While the ACA has brought insurance to 19 million Americans, 13 percent still lack health insurance, including one out of every five young adults. Notwithstanding the fact that the ACA has significantly reduced out-of-pocket costs, 21 percent of insured Americans are still spending 5 percent or more of their income on out-of-pocket costs.

This week I was joined by 44 members of Congress in reintroducing the only healthcare legislation that will overcome these persistent challenges to our healthcare system: H.R. 676, or “The Expanded and Improved Medicare for All Act.” This bill has been introduced in every Congress since 2003 and has a broad base of support among healthcare activists, organized labor, physicians, nurses, and social-justice organizations across the nation. The bill has been endorsed by 26 international unions, Physicians for a National Health Program, two former editors of the New England Journal of Medicine, National Nurses United, the American Medical Students Association, Progressive Democrats of America, the NAACP, and countless others.

This isn’t just good ethics; it’s also good economics. H.R. 676 will boost the economy by enabling America’s small businesses to focus on building their companies rather than on dealing with the cost and complexity of providing healthcare for their employees. H.R. 676 keeps the delivery of health care a private matter, enabling health providers to engage in market-based competition and innovation.

Half a century ago, addressing the convention of the Medical Committee for Human Rights, Martin Luther King Jr. declared, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” It’s time to adopt a serious comprehensive plan to address it.

Rep. John Conyers, D-Mich., is Dean of the U.S. House of Representatives and Ranking Member, House Judiciary Committee.

http://www.huffingtonpost.com/john-conyers/americas-new-single-payer_b_6616396.html

John Geyman’s timely book on ACA and single payer

How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans

By John Geyman, M.D.
Copernicus Healthcare, January, 2015

As we all know, the intense debate over Obamacare, or the Affordable Care Act (ACA), is a polarizing issue that sharply divides political parties and the public. Confusion reigns over its benefits, problems and prospects as claims and counterclaims fill press and media coverage.

This book is an attempt to make sense out of all of this – to cut through the rhetoric, disinformation and myths to assess what is good and bad about the ACA, and to ask whether or not it can remedy our system’s four main problems – uncontrolled costs, unaffordability, barriers to access, and mediocre, often poor quality of care.

In Part One, we will briefly trace historical roots of various reform attempts over the years, and summarize some of the major trends that have changed the delivery system, professional roles and values, the ethics of health care, and the role of government vs. the private sector. In Part Two, we will compare the ACA’s promises with realities of what it has accomplished, examine its initial outcomes on access, cost containment, affordability and quality of care, ask whether its flaws can be fixed with a private insurance industry, and point out the lessons that we can already take away from the first five years of the law. In Part Three, we will discuss the many myths that are perpetuated by opponents of single-payer national health insurance (NHI) and show how that approach stands ready to deal directly with what has become a national disgrace – our increasingly fragmented and cruel health care system that serves corporate interests at the expense of ordinary Americans. We will make the case for NHI in three ways – economic, social/political, and moral. Most other advanced countries around the world came to this conclusion many years ago.

Why this book now? With the 2014 midterm elections behind us, divisions between the parties are even more polarized. The future of health care is even more uncertain. The 2016 election cycle is already underway, and both parties have to confront the failures of yet another incremental attempt to reform our so-called health care system. We have a short year and a half to re-assess where we are and try once again to get health care reform right. As much of the public knows all too well, the stakes get higher every day.

http://www.copernicus-healthcare.org/

“How Obamacare Is Unsustainable” can be purchased through PNHP for $15.00, here. It is also available through Amazon.com and BarnesandNoble.com for $18.95.

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Comment:

By Don McCanne, MD

John Geyman has been a prolific writer of books describing the major deficiencies in health care in the United States, but “How Obamacare Is Unsustainable” is set apart from the others for a couple of important reasons. He explains what has been wrong with our five year experiment in reform and what we can do about it, and, especially pertinent, it is timed to coincide with a moment in history in which there will be an intense national dialogue recognizing the health care failures of the past and present, with a demand for political solutions as we enter the season of the 2016 presidential election.

Just today, Sen. Burr, Sen. Hatch and Rep. Upton released a nine page report being characterized as the Republican response to Obamacare (though Speaker Boehner has requested another, likely similar proposal from a House team that includes Rep. Upton). Unfortunately, the Burr/Hatch/Upton response is highly partisan and thus gets most of the policy wrong. Although the Affordable Care Act was conceived as a non-partisan solution, it too became partisan as the politics shifted from a largely right-wing concept advanced by Democrats (non-partisan) to an exclusively Democrat-endorsed proposal (highly partisan). In the turmoil, the result ended up being the most expensive model of reform, yet it contained terribly flawed policies that fall intolerably short of universality, affordability, accessibility, efficiency and equity. Both the Democrats and the Republicans are wrong.

As we enter the pending national dialogue on reform we need to move the rhetoric from partisan sniping to informed discussions of policy. We know where Congress lies in the highly-polarized partisan divide, but what about the nation?

According to a January 2015 Gallup poll, 42% of voters are Independents, 29% are Republicans, and 28% are Democrats. Thus a plurality is non-partisan.

According to that same Gallup poll, 45% of Independents support getting their insurance “through an expanded, universal form of Medicare.” To no surprise, 79% of Democrats also support universal Medicare, but, of great importance, 23% of Republicans do as well. When people understand policy, the partisan polarization diminishes.

At this time in history, it is imperative that all solutions be on the table, including those that give up on comprehensive reform (Burr/Hatch/Upton), those that perpetuate unacceptable mediocrity (the Affordable Care Act), and those that would actually achieve the goals that a large majority of Americans support (single payer, improved Medicare for all).

This is why John Geyman’s book is so timely. It is a book on optimal policy. It can be contrasted with today’s partisan release on the Republican answer to Obamacare. Their nine page proposal can be accessed at the following link: http://www.burr.senate.gov/public/_files/FINAL%20Patient%20CARE%20Act%20Plan.pdf

Partisan politics has not served us well with the Democrats giving us overpriced and mediocre reform and the Republicans proposing to further expose patients to the perverse dysfunctions of the market. Maybe Independents can help us stamp out partisanship and instead become serious about doing what is right for the nation.

Right now we have a chance to change history. We should make widely available John Geyman’s book based on sound, effective policy – just what the nation desperately needs.

I lost my MaineCare coverage, and it might make me sick

By Heather Denkmire
Bangor (Maine) Daily News, Feb. 4, 2015

Imagine this. You make an appointment with a doctor. You arrive, show your insurance card, and take a seat in the waiting area. You have your appointment. You leave. You pay nothing. You never receive a bill from an insurance company. You never have to call the doctor’s office or the insurance company — and wait on hold endlessly — to straighten out billing or reimbursement paperwork errors. You simply go to your doctor and receive medical care.

Now, also imagine that you pay no monthly premiums at all for health insurance. There are no deductibles. There are no co-pays. You choose your doctor. There are no “out of network” issues to consider. And, best of all, the insurance company won’t deny coverage, refuse to pay, and stick you with the bill.

For the last three years, I have used a version of “single payer health care” called MaineCare. Sure, there were a few bumps in the road. Some specialists had very limited hours available for MaineCare patients. A couple receptionists turned visibly cold, downright rude in one case, immediately after learning that I was a MaineCare patient. And, MaineCare did insist that I try less expensive alternatives before agreeing to pay for an absurdly expensive medication — $1,500 a month! — to treat my psoriasis.

Other than those minor inconveniences, how I paid for my health care hasn’t been a concern. I haven’t had to worry about finding the money for co-payments. I haven’t had to spend hundreds or thousands of dollars to meet a deductible. My health care was simply paid for with government funds. Those funds come from taxes, including those I have paid for the last 30 years.

About six months ago, I received a letter from DHHS informing me that I was being put onto “transitional MaineCare.” This meant my income would need to be verified more frequently to determine my continued eligibility. I immediately thought about how what was now a paperwork hassle would have been a devastating challenge just a few years ago when things were really tough personally and financially. On Jan. 10, I received a letter indicating my MaineCare coverage would end Jan. 31.

It’s been scary. I’ll admit I put off going to healthcare.gov to find health insurance because I didn’t want to face the fact that I will now have a dramatic increase in my monthly expenses. Suddenly I have monthly premiums. I will have to pay for doctor visits. I will have to pay for about 60 percent of much of my care until I meet my new plan’s deductible.

It’s true that the Affordable Care Act has made the costs lower than before. But there is nothing low about going from paying nothing to paying about $200 a month just for insurance. Remember my $1,500-a-month medication? No matter how much the new insurance covers, you can be sure I’ll have to spend up to my new insurance’s $1,500 maximum annual out-of-pocket amount. That’s $200 a month, co-pays, co-insurance until I meet the $500 deductible, and likely up to $1,500 because of the expensive medication. From $0 to $3,900 or more for one year.

The worry about new expenses could very well impact my overall health. Fear of costs — even reduced costs at a place like Community Dental (which, full disclosure, is a client of my grant writing business) — kept me from going to the dentist for over a year. I am sure the same thing will happen, as I know it does for other people, when it comes to easily treated minor health issues. Even $20 here and $10 there add up quickly when my bank balances are terribly low.

The frightening truth is the costs of paying for health insurance and health care now put me at risk of going back into serious financial crisis. The costs of another crisis would be exponential, negatively impacting my children, my work, my personal life, and my health.

A 7 percent increase in payroll taxes for businesses — with zero dollars paid to any health insurance company — and a 2 percent increase in personal income taxes — with zero premiums, co-pays, or co-insurance — is a price worth paying for ensuring everyone has access to high-quality healthcare. That’s what the Economic Policy Institute estimates it would take to pay for truly universal health coverage.

Again, imagine it. You visit your doctor without paying anything and without dealing with insurance companies at all. That is “single payer” health care.

For those of you who think a publicly financed universal health care means more bureaucracy, significantly higher taxes, or government control of your health care, I dare you to read the FAQ on the Physicians for a National Health Program website: https://www.pnhp.org/facts/single-payer-faq.

Heather Denkmire is a writer and artist who lives in Portland with her two young daughters. After a few challenging years, she is growing her small business, where her team helps nonprofit organizations win grants. She can be reached at column@grantwinners.net. Her columns appear monthly.

I lost my MaineCare coverage, and it might make me sick

Universal Healthcare Advocates Renew Push Toward Medicare-For-All

U.S. Rep. John Conyers says: ‘I believe that a single-payer, universal healthcare system is the only way we can truly reshape our broken system’

By Deirdre Fulton
Common Dreams, Feb. 4, 2015

Single-payer advocates are celebrating the reintroduction of the so-called ‘Medicare-for-All’ bill that would replace the nation’s byzantine healthcare system, dominated by private health insurance companies, with a single, streamlined public agency that would pay all medical claims for the entire population, much like Medicare does for seniors today.

Lead sponsor Rep. John Conyers Jr. (D-Mich) put forth the “Expanded and Improved Medicare for All Act” (H.R. 676) on Tuesday evening, along with 44 other House members. The legislation would create a publicly financed, privately delivered health care system that expands the already existing Medicare program to all U.S. residents and all residents living in U.S. territories. The bill has been defeated in three previous House sessions.

Proponents say the approach would vastly simplify how the nation pays for care, improve patient health, restore free choice of physician, eliminate co-pays and deductibles, and yield substantial savings for individuals, families, and the national economy.

At his website, Conyers says: “I believe that a single-payer, universal healthcare system is the only way we can truly reshape our broken healthcare system.”

Dr. Robert Zarr, president of Physicians for a National Health Program, a non-profit research and educational group of 19,000 doctors nationwide that supports Conyers’s bill, echoed that claim.

“The global evidence is very clear: single-payer financing systems are the most equitable and cost-effective way to assure that everyone, without exception, gets high-quality care,” Zarr said. “Medicare is a good model to build on, and what better way to observe Medicare’s 50th anniversary year than to improve and extend the program and its benefits to people of all ages?”

The Medicare-for-All bill would be an improvement on the Affordable Care Act, Zarr continued:

“[T]he enactment of Rep. Conyers’ bill would take us much further down the road to a humane, just and sustainable health care system than the 2010 health law, which, despite its modest benefits, will not be able to control costs and will still leave 31 million people uninsured in 2024, according to the Congressional Budget Office. Millions more will be inadequately insured, with skimpy coverage.

“As a doctor who sees the children of hard-pressed parents every day, I can tell you that the need for fundamental health care reform has never been greater. It’s time to stop putting the interests of private insurance companies and Big Pharma over patient needs. It’s time to adopt a single-payer, improved-Medicare-for-all program in the United States.”

Last month, Common Dreams reported that just over 50 percent of Americans—and more than 80 percent of Democrats—say they still support the idea of single-payer healthcare, according to a poll by the Progressive Change Institute.

Meanwhile, the Republican-controlled House voted Tuesday largely along party lines to repeal and replace Obamacare. The legislation is likely to fail in the U.S. Senate and would certainly be vetoed by President Obama should it reach his desk.

Dierdre Fulton is a staff writer at Common Dreams.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License.

http://www.commondreams.org/news/2015/02/04/universal-healthcare-advocates-renew-push-toward-medicare-all

A doctor’s prescription for health care

By Anna Carey, M.D.
VTDigger.org, Jan. 27, 2015

A 60-year-old man, who I’ll call C.C., recently walked into my family medical practice. The nurse handed me a thin chart record. His last visit was five years before for a skin infection. Written across the top in large block letters were the words, “NO INSURANCE.”

C.C. and I started talking. Over the past month, he’d experienced darkening and diminishing urine, clay colored stools, fatigue, nausea, abdominal pain, parched mouth, and windedness. His vitals weren’t good. He had a rapidly irregular heart rate of 130 beats per minute, and a low blood pressure of 98/52. With the aid of a urine test, ECG, chest X-ray, I knew C.C. was severely ill with kidney disease, jaundice and atrial fibrillation. I could only broadly diagnose, however. He clearly needed more in-depth evaluation: immediate blood work, an abdominal CAT scan, and urgent measures to replenish his dehydrated body. But, as C.C. reminded me, he didn’t have insurance. He and his wife own a store, and he earns extra income doing carpentry on the side. Costly health insurance premiums, deductibles, co-payments were not things that he could afford. He asked me whether he could delay treatment, and potentially emergency hospitalization, until he was able to get insurance.

How absurd is this system? Those who defend out-of-pocket costs claim that they discourage the overuse of care, but as a doctor, I see that they make my professional medical opinions irrelevant and deny my patients care. The market-based insurance system, in effect, was denying C.C. the urgent care he needed, leaving both him and me powerless to do anything.

C.C. was stuck in what people in the business world call “churn.” In business, churn describes customer turnover; in medicine, where people with real medical needs are treated like consumers, its effect is to disrupt care. Over the last 20 years, I have seen this business phenomenon recklessly infect medicine. People like C.C. churn in and out of health insurance plans as their age, employment, health, income changes. Health care providers churn patients in and out of offices with “eight-minute” appointments. And an endless churn of reforms — paperwork, electronic medical records, accountable care organizations — do little to free patient-doctor decision-making from interference by middlepersons, and nothing to move us away from the market-based insurance system that puts financial interests ahead of people’s needs.

As a doctor, I am fortunate to have a good degree of financial security, but as a patient, I am affected by this broken system too. My son and I both deal with chronic conditions each day, and this year, getting the treatment we need has meant paying an $11,500 deductible above and beyond the $7,000 annual premium for my Bronze Blue Cross/Blue Shield insurance plan. What about my patients, neighbors and friends with less financial security? I urge all of us to focus our hearts and consciences on human dignity, and to recognize that our dignity depends upon universal, publicly financed health care. We need to step beyond the gimmicks of private health insurance schemes that stratify us into multi-tiered divisions and produce inequity among people.

I urge the Vermont Legislature to move beyond destructive co-pays, deductibles, premiums and inequitable tiers of access to health care. Let us do the right thing and create a universal, publicly financed Green Mountain health care system that includes everyone in Vermont from cradle to grave. If you agree, join us on Jan. 29 for a human rights vigil at the Vermont Statehouse cafeteria, details at workerscenter.org.

Dr. Anna Carey lives in Burlington and works at a family practice in Cambridge.

Anna Carey: A doctor’s prescription for health care

Use H.R. 676 to unify the reform movement

Doctors group hails reintroduction of Medicare-for-all bill

Physicians for a National Health Program, February 4, 2015

Single-payer health program would cover all 42 million uninsured, upgrade everyone’s benefits and save $400 billion annually on bureaucracy, physicians say

A national physicians group today hailed the reintroduction of a federal bill that would upgrade the Medicare program and swiftly expand it to cover the entire population.

The “Expanded and Improved Medicare for All Act,” H.R. 676, introduced last night by Rep. John Conyers Jr., D-Mich., with 44 other House members, would replace today’s welter of private health insurance companies with a single, streamlined public agency that would pay all medical claims, much like Medicare works for seniors today.

Proponents say a Medicare-for-all system, also known as a single-payer system, would vastly simplify how the nation pays for care, improve patient health, restore free choice of physician, eliminate copays and deductibles, and yield substantial savings for individuals, families and the national economy.

“The global evidence is very clear: single-payer financing systems are the most equitable and cost-effective way to assure that everyone, without exception, gets high-quality care,” said Dr. Robert Zarr, president of Physicians for a National Health Program, a nonprofit research and educational group of 19,000 doctors nationwide.

“Medicare is a good model to build on, and what better way to observe Medicare’s 50th anniversary year than to improve and extend the program and its benefits to people of all ages?”

Zarr, a Washington, D.C.-based pediatrician, continued: “An expanded and improved Medicare-for-All program would assure truly universal coverage, cover all necessary services, and knock down the growing financial barriers to care – high premiums, co-pays, deductibles and coinsurance – that our nation’s patients and their families are increasingly running up against, often with calamitous results.

“Such a plan would save over $400 billion a year currently wasted on private-insurance-related bureaucracy, paperwork and marketing. That’s enough money to provide first-dollar coverage for everyone in the country – without increasing U.S. health spending by a single penny.

https://www.pnhp.org/news/2015/february/doctors-group-hails-reintroduction-of-medicare-for-all-bill

****

H.R.676 – To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.

114th Congress

Introduced:  02/03/2015

Sponsor:  Rep. Conyers, John, Jr. [D-MI-13] (Introduced 02/03/2015)

Cosponsors:  44

Committees:  House – Energy and Commerce; Natural Resources; Ways and Means

Latest Action:  02/03/2015 Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

https://www.congress.gov/bill/114th-congress/house-bill/676/cosponsors

****

Comment:

By Don McCanne, MD

Last night, Rep. John Conyers reintroduced in the 114th Congress H.R. 676, his single payer bill based on an expanded and improved Medicare that would cover everyone. Although the implementation of the Affordable Care Act has diverted attention from this model of reform that actually would provide affordable care for everyone, nevertheless, its reintroduction provides us with actual legislation that we can use in our advocacy for a more efficient and effective health care program for the nation.

Those who are attempting to establish state-level single payer systems will find this legislation to be essential since it addresses the federal barriers that prevent states from establishing a bona fide single payer system. Vermont’s experience showed us that they had to abandon the single payer concept early on because of these barriers, though they continue to try to move forward with incremental measures that can never lead to single payer, that is without enabling federal legislation.

H.R. 676 should be used by all supporters of health care justice as an advocacy piece to further educate the public at large on the clear moral imperative of the single payer model. That includes those working on state single payer systems and those busy helping to implement the Affordable Care Act. No matter how busy you are, you still need to use every opportunity to advocate for a system that takes care of the health care needs of the entire nation. The Affordable Care Act does not do that.

H.R. 676 has been posted to the Congress.gov website (link above), and within the next few days, the entire text of the bill will be added. Right now you can see the list of the 44 cosponsors and then use that list to encourage other members of Congress to become cosponsors as well. The Republicans concur that the Affordable Care Act needs to be replaced with a program that actually is affordable and portable. A minority of Republican and Independent voters understand that an improved Medicare for everyone would be an ideal solution. As we craft our messages, we must keep Republicans and Independents in mind. We care about their health as well.

At any rate, make H.R. 676 the central piece of your advocacy for health care justice for all. The nation’s health depends on it.

Use H.R. 676 to unify the reform movement

Doctors group hails reintroduction of Medicare-for-all bill

Physicians for a National Health Program, February 4, 2015

Single-payer health program would cover all 42 million uninsured, upgrade everyone’s benefits and save $400 billion annually on bureaucracy, physicians say

A national physicians group today hailed the reintroduction of a federal bill that would upgrade the Medicare program and swiftly expand it to cover the entire population.

The “Expanded and Improved Medicare for All Act,” H.R. 676, introduced last night by Rep. John Conyers Jr., D-Mich., with 44 other House members, would replace today’s welter of private health insurance companies with a single, streamlined public agency that would pay all medical claims, much like Medicare works for seniors today.

Proponents say a Medicare-for-all system, also known as a single-payer system, would vastly simplify how the nation pays for care, improve patient health, restore free choice of physician, eliminate copays and deductibles, and yield substantial savings for individuals, families and the national economy.

“The global evidence is very clear: single-payer financing systems are the most equitable and cost-effective way to assure that everyone, without exception, gets high-quality care,” said Dr. Robert Zarr, president of Physicians for a National Health Program, a nonprofit research and educational group of 19,000 doctors nationwide.

“Medicare is a good model to build on, and what better way to observe Medicare’s 50th anniversary year than to improve and extend the program and its benefits to people of all ages?”

Zarr, a Washington, D.C.-based pediatrician, continued: “An expanded and improved Medicare-for-All program would assure truly universal coverage, cover all necessary services, and knock down the growing financial barriers to care – high premiums, co-pays, deductibles and coinsurance – that our nation’s patients and their families are increasingly running up against, often with calamitous results.

“Such a plan would save over $400 billion a year currently wasted on private-insurance-related bureaucracy, paperwork and marketing. That’s enough money to provide first-dollar coverage for everyone in the country – without increasing U.S. health spending by a single penny.

https://www.pnhp.org/news/2015/february/doctors-group-hails-reintroduction-of-medicare-for-all-bill

****

H.R.676 – To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.

114th Congress

Introduced:  02/03/2015

Sponsor:  Rep. Conyers, John, Jr. [D-MI-13] (Introduced 02/03/2015)

Cosponsors:  44

Committees:  House – Energy and Commerce; Natural Resources; Ways and Means

Latest Action:  02/03/2015 Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

https://www.congress.gov/bill/114th-congress/house-bill/676/cosponsors

****

Comment:

By Don McCanne, MD

Last night, Rep. John Conyers reintroduced in the 114th Congress H.R. 676, his single payer bill based on an expanded and improved Medicare that would cover everyone. Although the implementation of the Affordable Care Act has diverted attention from this model of reform that actually would provide affordable care for everyone, nevertheless, its reintroduction provides us with actual legislation that we can use in our advocacy for a more efficient and effective health care program for the nation.

Those who are attempting to establish state-level single payer systems will find this legislation to be essential since it addresses the federal barriers that prevent states from establishing a bona fide single payer system. Vermont’s experience showed us that they had to abandon the single payer concept early on because of these barriers, though they continue to try to move forward with incremental measures that can never lead to single payer, that is without enabling federal legislation.

H.R. 676 should be used by all supporters of health care justice as an advocacy piece to further educate the public at large on the clear moral imperative of the single payer model. That includes those working on state single payer systems and those busy helping to implement the Affordable Care Act. No matter how busy you are, you still need to use every opportunity to advocate for a system that takes care of the health care needs of the entire nation. The Affordable Care Act does not do that.

H.R. 676 has been posted to the Congress.gov website (link above), and within the next few days, the entire text of the bill will be added. Right now you can see the list of the 44 cosponsors and then use that list to encourage other members of Congress to become cosponsors as well. The Republicans concur that the Affordable Care Act needs to be replaced with a program that actually is affordable and portable. A minority of Republican and Independent voters understand that an improved Medicare for everyone would be an ideal solution. As we craft our messages, we must keep Republicans and Independents in mind. We care about their health as well.

At any rate, make H.R. 676 the central piece of your advocacy for health care justice for all. The nation’s health depends on it.

Physician calls for single-payer health care system in NH

By Garry Rayno
The Union Leader (Manchester, N.H.), Feb. 3, 2015

CONCORD, N.H. — “Who do you want to pay?” was the question a Dover physician asked in supporting a bill for a single-payer health care system in the state.

Pushed by Granite State Physicians for a National Health Program, House Bill 686 would provide health care to all the state’s residents who fill out an application form while doing away with private carriers.

Supporters told the House Commerce Committee members Tuesday the bill would better allow the state to control health care costs while every citizen would be covered.

But opponents said the bill would double the state’s budget, raise taxes and cripple key industries in the state.

“This is not a not ready for prime time bill,” said Americans for Prosperity NH Director Greg Moore, “This is a bad bill.”

But the bill’s prime sponsor said it is an opportunity for the state to control costs and provide health care for all its citizens.

“This will fix health care in New Hampshire,” said Rep. Richard McNamara, D-Hillsborough. “We know our people, we know what our needs are.”

Under the bill, every New Hampshire citizen would be eligible for health care after filling out an application. There would be no co-pays nor deductibles.

Hospitals would receive a lump sum monthly payment negotiated by the state.

A health services governing board would oversee the program and a health services trust fund would be established to pay providers.

There is no mechanism to pay for the program in House Bill 686, which would go into effect 60 days after it passes, which is unlikely this year.

At the public hearing, family physician James Fieseher of Dover told the House Commerce and Consumer Affairs Committee the current health care system is broke.

“I don’t like to waste money. I don’t like to waste my money and I don’t like to see the state waste money,” he said. “We need to do something about a broken system we cannot afford. The system is a leaking boat.”

He said the current system requires health care providers to treat people who cannot pay for their care, and that drives up the cost for everyone.

“That’s like mandating supermarkets give away free food to those who cannot afford to pay,” Fieseher told the committee. “You drive up costs for everyone.”

With the state overseeing the health care system, he said, health care costs would go down. The people who cannot afford it now will continue to have health care, but providers will be paid for their services, he said.

Currently, the average health insurance plan costs about $15,000 a year with copays and deductibles, Fieseher said. “That is a private tax, not a government tax, paid to a private company with no investment to make the system cheaper,” he said. “The question is who do you want to pay?”

But Moore told the committee Vermont recently canceled its plans to move to a single-payer system because of costs.

He noted the plan would have cost $2.6 billion, and with Vermont about half the size of New Hampshire, the projected costs here would be $5.2 billion, which is almost equal to the current annual state budget.

Moore said one of the reasons the Vermont plan was scrapped was the cost on business and individuals, an 11.5 percent tax on payroll and an up to 9 percent tax on individual income.

The owner of Sugarbush ski area said the plan would have increased his health care costs by 61 percent, said Moore, and that would be true for all seasonal employers.

“That would be a huge hit on our tourism industry,” Moore said. And, he added, he has concerns about out-of-state coverage for state residents.

“There are a lot of fundamental problems,” Moore said, “The biggest is how to pay for it.”

The committee did not make an immediate recommendation on the bill.

Garry Rayno is with the State House Bureau.

http://www.unionleader.com/section/services09